WHEN DR. RICHARD JACKSON speaks to groups of developers, landscape architects, city planners and others making decisions about land use in cities across the United States, he explains that whether they realize it or not, their actions are vital to the public’s health.

“Many of them have more impact on people’s health than doctors,” says Jackson, a pediatrician and professor in the Fielding School’s Department of Environmental Health Sciences. “As physicians, we’re often at the end of the disease pipeline trying to undo the results of years of physical inactivity and unhealthy eating, much of which is influenced by the living environment.”

During his nine-year tenure as director of the National Center for Environmental Health of the U.S. Centers for Disease Control and Prevention, Jackson became a pioneering voice for the notion that the design of cities is a key determinant of the health of their inhabitants. Much was known about the important role of social determinants of health (including factors such as income and education), but Jackson noted that in many parts of the world people who were poor and had limited schooling tended to be healthier than those living in more affluent, better-educated U.S. communities with environments not conducive to an active lifestyle.

“Beginning in the 1950s, we emptied our cities, sprawled everyone across the landscape and became dependent on automobiles,” Jackson says. “Sitting in our cars rather than living in walkable cities has led to two of our biggest public health problems, obesity and stress. When I give talks in Los Angeles, people say their commute is the hardest part of their day. Not their job – their commute.”

“Sitting in our cars rather than living in walkable cities has led to two of our biggest public health problems, obesity and stress.” — Richard Jackson

Today, in addition to his FSPH teaching and research activities, Jackson frequently lectures, writes and consults on ways to make urban environments more aligned with public health goals – some of which he spelled out as the host/narrator of “Designing Healthy Communities,” a four-hour PBS series that first aired in 2011. But amid growing recognition that a well-designed built environment may hold the key to addressing some of the nation’s major public health concerns – from cardiovascular disease, diabetes, and other obesity-related conditions to asthma and depression – Jackson is far from alone. At the Fielding School, across the UCLA campus, throughout Los Angeles and beyond, momentum is on the side of shaping the built environment in ways that promote active living, social engagement and economic growth.

“We’re in an exciting transition, where Los Angeles is moving away from the idea that we have to be a car-centric city and toward building communities that are healthy and sustainable,” says Tyler Watson, a doctoral student in the Fielding School’s Department of Environmental Health Sciences who worked with Jackson on “Urban River Parkways: An Essential Tool for Public Health,” a report for the Sacramento-based nonprofit Resources Legacy Fund on the public health benefits of connecting parks and other recreational spaces with residential and commercial centers in populated areas along rivers and other bodies of water.

“Public health education and interventions are definitely needed,” adds Watson, “but if you can influence the actual spaces where people live, work and play so that it becomes safe and appealing for them to be more active and not depend on their cars for every trip they make, that can have a huge impact.”

In the process of developing their report on the public health impacts of urban river parkways, Jackson and Watson became involved with the L.A. River Revitalization Corp., a nonprofit group working to catalyze sustainable land-use projects along a restored Los Angeles River. The group’s ultimate vision is of a 51-mile greenway corridor that would support many of the goals laid out in the Fielding School team’s report – vibrant communities along the river with ample green spaces, bike paths, trails, public art and thriving businesses. The City of Los Angeles has developed an L.A. River Revitalization Master Plan, and under an agreement between the city and the federal government, an initial 11-mile section of the river, stretching roughly from Griffith Park to Downtown Los Angeles, is now slated for a $1 billion restoration effort.

“There’s a lot of talk about the environmental and economic benefits of restoring urban rivers that have been concrete channels for decades, and we are helping to bring the public health argument into the discussions,” says Watson. “The L.A. River goes through parts of the city that lack convenient and accessible open spaces for physical activity and have some of the city’s highest rates of obesity and chronic disease. This is a natural resource that can be used not only for flood control, but also to provide irresistible opportunities for active living, to the benefit of city dwellers.

FUNCTIONAL SEPARATION is a term that describes the conventional landscape of the U.S., particularly in suburban areas: large swaths of communities that are only residential, resulting in increased traffic as people are forced to use their cars to access commercial areas and get to work. It’s no coincidence, says Dr. Michael Jerrett, professor and chair of the Fielding School’s Department of Environmental Health Sciences, that this pattern of development starting in the second half of the 20th century has been accompanied by reduced physical activity and increased rates of obesity.

“Smart-growth communities are a response to the shortcomings of these conventionally designed communities,” says Jerrett. “They’re an effort not only to make the landscape denser and more walkable, but also to ensure that residents have easy access to attractive green spaces and recreational opportunities.”

More than a decade ago, as he saw the concept beginning to pick up steam, Jerrett applied for and received funding from the National Cancer Institute to test the hypothesis that a smart-growth community would promote more active lifestyles, leading to reduced obesity rates. For the study, children and their parents in a smart-growth community in the Southern California city of Chino and those in eight conventionally designed communities in the surrounding area were tracked for four years through geographic position and accelerometry technologies to determine physical activity and location information.

“Smart-growth communities are an effort to make the landscape denser and more walkable, [and] to ensure that residents have easy access to attractive green spaces and recreational opportunities.” — Michael Jerrett

Publishing in the American Journal of Preventive Medicine in 2013, Jerrett’s group reported that children in the study’s smart-growth community participated in 46 percent more moderate-to-vigorous physical activity within their neighborhood than children in the conventionally designed communities. Jerrett is also part of a large consortium that has conducted a number of studies in Europe and North America showing that improved access to well-maintained parks and recreational spaces adjacent to water is associated with increased physical activity and reduced body mass index levels in children.

The elements of a “healthy community” vary, but generally feature an infrastructure that supports active transportation – attractive sidewalks, safe-to-use bike lanes, reliable public transit; well-maintained and well-lit park spaces that promote multigenerational recreation; and a mix of land uses, including a vibrant combination of commerce and the arts to encourage foot traffic.

Farmer’s markets are a key feature of "healthy cities".

The most obvious benefit of such communities from a public health standpoint is the promotion of physical activity. An estimated 80 percent of U.S. adults fail to put in the minimum recommended amount of exercise (either 2.5 hours per week of moderate-intensity aerobic exercise, an hour and 15 minutes per week of vigorous-intensity activity, or a combination), according to the Centers for Disease Control and Prevention. But built environment experts at the Fielding School and beyond point to other important benefits. Creating an appealing shared space that brings people out for shopping, dining and strolling rather than keeping them confined in their cars not only helps local businesses to flourish, but also potentially increases civic engagement and social interaction. Walking, biking and public transportation reduce both noise and emissions from motor vehicle traffic, improving air quality. And improved quality of life, increased physical activity and more appealing surroundings all add up to reductions in stress, among other mental health benefits.

Uyen Ngo (MPH '13) at CicLAvia open-streets events

“EVEN MODERATE AMOUNTS of physical activity such as climbing the stairs at work or walking to the grocery store can make a huge difference in people’s health, and a well-designed city makes these active lifestyle options convenient and possible,” says Uyen Ngo (MPH ’13), who earned degrees from the Fielding School and UCLA’s Luskin School of Public Affairs Department of Urban Planning and now serves as a policy analyst for the Los Angeles County Department of Public Health’s Policies for Livable Active Communities and Environments (PLACE) program.

A recognition that the design of cities can play an important role in reducing chronic conditions and improving quality of life led the county public health department to establish PLACE in 2006. Featuring both a competitive grant-awarding process and direct technical assistance in low-resourced areas, PLACE works with cities to develop plans and/or policies that promote active lifestyles through engineering, programming and outreach. “If the streets are lively with attractive landscaping, lots of shops, wide sidewalks and good lighting, you get people away from a sedentary lifestyle and build a better sense of community,” Ngo says.

Ngo co-managed a direct technical assistance project with the City of Cudahy, located in southeastern Los Angeles County, on a “safe routes to school” plan to increase walking and biking among children through safety changes to the streets and sidewalks, collaborations with law enforcement to address concerns about crime and motor vehicle driver behavior, and training parents on developing programs such as supervised walking clubs for children. In a separate partnership with the City of Los Angeles and the Los Angeles County Bicycle Coalition, Ngo oversaw the development of the “Active Streets LA” toolkit, which educated community members on urban design options to create safer streets for pedestrians and bicyclists. PLACE has also provided funding for the nonprofit organization CicLAvia to hold open-streets events promoting physical activity in low-income cities in southeast Los Angeles where there are high rates of obesity and obesity-related chronic diseases.

Launched in 2008, CicLAvia has become a nationally recognized leader in “open streets” programs, in which a section of city streets is temporarily closed to vehicular traffic for events that promote walking and biking, local commerce, and community engagement. Inspired by a tradition that started 40 years ago in Bogotá, Colombia, CicLAvia has drawn hundreds of thousands of people to free events that are now held several times a year in various parts of Los Angeles. “The open streets movement is growing, and because it has been so popular here, many cities are looking to Los Angeles for lessons on how to emulate this model,” says Christina Batteate (MPH ’12), project manager in the Sustainable Technology and Policy Program (STPP), a joint venture of the Fielding School and UCLA School of Law that brings together multidisciplinary teams from the two schools and other parts of the UCLA campus to tackle environmental health problems through research and policy development.

Batteate has helped to spearhead STPP’s built environment efforts, working with Jackson, Jerrett, and Drs. John Froines and Brian Cole from the Fielding School as well as faculty members from the UCLA Luskin School of Public Affairs. The group, with Cole as the principal investigator, has been studying CicLAvia events to learn more about the types of people who are drawn to them, the effect on physical activity and their level of interest in having such programs in their neighborhoods. “Our goal is to use this evidence to make recommendations for how to improve this process, while keeping in mind that this will serve as a case study to inform the open streets efforts of other cities,” Batteate explains.

The STPP built environment group is working with a variety of partners outside of UCLA, including CicLAvia and other community-based organizations as well as the L.A. Mayor’s Office and L.A. Department of Transportation. A project funded by the California Department of Transportation (Caltrans), also headed by Cole, is seeking to identify the best practices for plans to convert Caltrans-owned highways in urban areas into more livable streets. Batteate has also led an STPP effort to create a mobile phone application measuring walkability in cities. “We all share a vision of communities in which the environment supports healthy living – particularly in urban areas, since we live in one of the nation’s great mega-cities,” Batteate says. “As researchers at UCLA, we can provide evidence-based recommendations that might facilitate change in our local environment while serving as a model for large cities everywhere.”

MPH student Jimmy Tran conducted surveys at CicLAvia

JIMMY TRAN was drawn to the Fielding School in part by Jackson’s leadership in promoting the public health benefits of well-designed communities. “It just made a lot of sense to me that with the problems we face involving obesity and chronic diseases, we need to look more closely at how the physical environment, including the transportation infrastructure, affects people’s health,” says Tran, who is working toward both his MPH in FSPH’s Department of Environmental Health Sciences and an MA in Urban Planning. Reflecting the growing recognition of the public health importance of urban planning decisions, the FSPH and UCLA Department of Urban Planning now offer a formal curriculum for students interested in pursuing the dual degree.

Tran serves as co-chair of the UCLA Built Environment and Public Health Council (BEPHC), a new student group that promotes research and education on the relationships between the built environment and public health. The group has hosted speakers and screened documentaries on issues related to healthy communities, as well as participating in National Public Health Week events. “This is serving to foster conversation and raise awareness,” Tran says. “A lot of students are very interested in how they can get involved academically and professionally in this field.”

Tran and other Fielding School students are finding many outlets to get involved close to home, not only through the BEPHC but also as part of the UCLA Healthy Campus Initiative, a campus-wide effort (under the leadership of Associate Vice Provost Wendy Slusser, a member of the Fielding School faculty) to promote healthy lifestyle choices and develop best practices that can be applied in other communities. The initiative includes a section on the built environment and health – both on campus and in the surrounding community – headed by Jackson, with active participation by many FSPH students.

FSPH students install an herb garden in the courtyard of the UCLA Center for Health Sciences building.

Much of the focus has been on partnering with groups such as UCLA Transportation, UCLA Bike Shop, the campus architect and others to make walking and biking around campus safer and more appealing. The group has worked with local businesses and public officials on a push to build protected bike lanes in Westwood Village and to promote a bike-sharing program for the campus and the village. Watson and other Fielding School students have also promoted an initiative, underway, to make the FSPH stairwells more visible and inviting as a strategy to encourage more physical activity among people who would otherwise opt for the elevators.

Any effort to fundamentally change the way communities are designed is bound to encounter some resistance. Jerrett notes that some developers hesitate to move away from profitable business models, and bylaws and planning regulations in many communities foster suburban sprawl as opposed to smart-growth concepts. But, he adds, governments can induce the types of changes that promote these concepts, and many are doing just that. In California, the Sustainable Communities and Climate Protection Act, signed into law in 2008, aims to reduce greenhouse gas emissions through coordinated transportation and land-use planning. As part of the law, municipalities are mandated to develop smart-growth plans that promote public transit and “complete streets” that serve the needs of pedestrians and bicyclists as well as cars.

Jackson, who has seen a dramatic increase in the popularity of ideas he began advancing 15 years ago, believes there is no turning back. “This wasn’t mainstream when we first started talking about it, but it has gained tremendous traction,” he says. “When people see the kind of lifestyle you can have in communities that take these common-sense measures to improve the physical environment, they are voting with their feet.” •